Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2025
Randomized Controlled TrialEffect of intraoperative methadone in robot-assisted cystectomy on postoperative opioid requirements: A randomized clinical trial.
Postoperative pain management is a challenge after robot-assisted cystectomy (RAC). Methadone has a long duration of action, and we therefore hypothesized that a single dose of intraoperative methadone would reduce postoperative opioid requirements and pain intensity in bladder cancer patients undergoing RAC. ⋯ A single dose of intraoperative methadone does not reduce postoperative opioid requirements compared with a single dose of morphine in bladder cancer patients undergoing RAC.
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Acta Anaesthesiol Scand · Jan 2025
Comparative StudyPreferences and attitudes on acetate- versus lactate-buffered crystalloid solutions for intravenous fluid therapy-An international survey.
Clinical practice guidelines recommend use of buffered crystalloid solutions in critically ill patients but do not distinguish between solutions based on different buffering anions, that is, acetate- versus lactate-buffered solutions. We therefore surveyed relevant physicians about their preferences and attitudes toward each solution. ⋯ In this international survey, the reported use of buffered crystalloid solutions was high. Availability of the different solutions varied widely. The support for a potential randomized trial was high, with the clinical importance rated important but not critical by most respondents.
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Acta Anaesthesiol Scand · Jan 2025
Comparative StudyComparison of venous and calculated blood gas values to arterial values in critically ill patients.
Arterial blood gas (ABG) values are important in the assessment of critically ill patients. However, arterial puncture may be challenging to perform in these patients. The venous-to-arterial conversion method (v-TAC) is used to convert venous blood gas values to calculated values meant to resemble arterial values. Calculated pH and partial pressure of carbon dioxide (PCO2) values have shown good agreement with arterial values in stable patients, but performance of the method in patients with severe acid-base disturbances is unknown. We aim to evaluate venous and calculated blood gas value congruency with arterial values in critically ill patients. ⋯ Venous and calculated pH and PCO2 values showed similar congruency with arterial values in patients with alkalemia and moderate acidaemia, while the method was unreliable in a patient suspected of severe metabolic acidaemia.
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Acta Anaesthesiol Scand · Jan 2025
Observational StudyEffects of morning versus afternoon surgery on peri-operative disturbance of sleep-wake timing: An observational study.
The circadian timing system regulates diurnal sleep-wake rhythm. Previously, we showed that, in patients undergoing elective surgery, sleep-wake timing is altered and post-operative sleep quality is reduced. However, how the timing of the surgical procedure affects the disturbance and what other factors affect this disturbance remain unknown. ⋯ Timing of surgery may impact post-operative sleep. However, in this prospective cohort study of elective surgical patients, sleep-wake timing and post-operative sleep quality did not differ between those undergoing morning versus afternoon surgery.
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Acta Anaesthesiol Scand · Jan 2025
Does cytochrome 2D6 genotype affect the analgesic efficacy of codeine after ambulatory surgery? Prospective trial in 987 adults.
Paracetamol-codeine combination tablet is widely used in pain management after day surgery. For safety reasons, its use has decreased in recent years. Codeine is a prodrug metabolised in the liver by the cytochrome P450 2D6 (CYP2D6) enzyme to morphine that produces the analgesic effect of codeine. CYP2D6 is highly polymorphic, and based on genotypes, individuals can be divided into four categories: poor-, intermediate-, normal- and ultrarapid metabolisers. Differences in morphine and its metabolite concentrations have been described between different CYP2D6 genotypes following codeine administration. The aim of the study was to investigate the possible effect of CYP2D6 genotype on codeine efficacy and adverse effects in a large cohort of adult patients undergoing ambulatory surgery. ⋯ CYP2D6 genotype appears to be of minor importance for the analgesic efficacy of oral paracetamol-codeine combination therapy after ambulatory surgery in adult patients undergoing similar types of surgery as in the present study but it may affect the risk of constipation.